A Novel Lactobacillus brevis Fermented with a Vegetable Substrate (AL0035) Counteracts TNBS-Induced Colitis by Modulating the Gut Microbiota Composition and Intestinal Barrier

Crohn's and ulcerative colitis are common conditions associated with inflammatory bowel disease as well as intestinal flora and epithelial barrier dysfunction. A novel fermented Lactobacillus brevis (AL0035) herein assayed in a trinitro benzene sulfonic acid (TNBS)-induced colitis mice model after oral administration significantly counteracted the body weight loss and improves the disease activity index and histological injury scores. AL0035 significantly decreased the mRNA and protein expression of different pro-inflammatory cytokines (TNFalpha, IL-1beta, IL-6, IL-12, IFN-gamma) and enhanced the expression of IL-10. In addition, the probiotic promoted the expression of tight junction proteins, such as ZO-1, keeping the intestinal mucosal barrier function to attenuate colitis symptoms in mice. Markers of inflammation cascade such as myeloperoxidase (MPO) and PPAR-gamma measured in the colon were also modified by AL0035 treatment. AL0035 was also able to reduce different lymphocyte markers' infiltration in the colon (GATA-3, T-Bet, NK1.1) and monocyte chemoattractant protein-1 (MCP-1/CCL2), a key chemokine involved in the migration and infiltration of monocytes/macrophages in the immunological surveillance of tissues and inflammation. In colonic microbiota profile analysis through 16S rRNA sequencing, AL0035 increased the microbial diversity depleted by TNBS administration and the relative abundance of the Lactobacillaceae and Lachnospiraceae families, whereas it decreased the abundance of Proteobacteria. Altogether, these data indicated that AL0035 could lower the severity of colitis induced by TNBS by regulating inflammatory cytokines, increasing the expression of tight junction proteins and modulating intestinal microbiota, thus preventing tissue damage induced by colitis.

Effect of glycosylation on the affinity of the MTB protein Ag85B for specific antibodies: towards the design of a dual-acting vaccine against tuberculosis

BACKGROUND

To create a dual-acting vaccine that can fight against tuberculosis, we combined antigenic arabino-mannan analogues with the Ag85B protein. To start the process, we studied the impact of modifying different parts of the Ag85B protein on its ability to be recognized by antibodies.

RESULTS

Through our research, we discovered that three modified versions of the protein, rAg85B-K30R, rAg85B-K282R, and rAg85B-K30R/K282R, retained their antibody reactivity in healthy individuals and those with tuberculosis. To further test the specificity of the sugar AraMan for AraMan antibodies, we used Human Serum Albumin glycosylated with AraMan-IME and Ara3Man-IME. Our findings showed that this specific sugar was fully and specifically modified. Bio-panning experiments revealed that patients with active tuberculosis exhibited a higher antibody response to Ara3Man, a sugar found in lipoarabinomannan (LAM), which is a major component of the mycobacterial cell wall. Bio-panning with anti-LAM plates could eliminate this increased response, suggesting that the enhanced Ara3Man response was primarily driven by antibodies targeting LAM. These findings highlight the importance of Ara3Man as an immunodominant epitope in LAM and support its role in eliciting protective immunity against tuberculosis. Further studies evaluated the effects of glycosylation on the antibody affinity of recombinant Ag85B and its variants. The results indicated that rAg85B-K30R/K282R, when conjugated with Ara3Man-IME, demonstrated enhanced antibody recognition compared to unconjugated or non-glycosylated versions.

CONCLUSIONS

Coupling Ara3Man to rAg85B-K30R/K282R could lead to the development of effective dual-acting vaccines against tuberculosis, stimulating protective antibodies against both AraMan and Ag85B, two key tuberculosis antigens.

Novel frontiers in neuroprotective therapies in glaucoma: Molecular and clinical aspects

In the last years, neuroprotective therapies have attracted the researcher interests as modern and challenging approach for the treatment of neurodegenerative diseases, aimed at protecting the nervous system from injuries. Glaucoma is a neurodegenerative disease characterized by progressive excavation of the optic nerve head, retinal axonal injury and corresponding vision loss that affects millions of people on a global scale. The molecular basis of the pathology is largely uncharacterized yet, and the therapeutic approaches available do not change the natural course of the disease. Therefore, in accordance with the therapeutic regimens proposed for other neurodegenerative diseases, a modern strategy to treat glaucoma includes prescription of drugs with neuroprotective activities. With respect to this, several preclinical and clinical investigations on a plethora of different drugs are currently ongoing. In this review, first, the conceptualization of the rationale for the adoption of neuroprotective strategies for retina is summarized. Second, the molecular aspects highlighting glaucoma as a neurodegenerative disease are reported. In conclusion, the molecular and pharmacological properties of most promising direct neuroprotective drugs used to delay glaucoma progression are examined, including: neurotrophic factors, NMDA receptor antagonists, the α2-adrenergic agonist, brimonidine, calcium channel blockers, antioxidant agents, nicotinamide and statins.

The Insulin-Degrading Enzyme from Structure to Allosteric Modulation: New Perspectives for Drug Design

The insulin-degrading enzyme (IDE) is a Zn2+ peptidase originally discovered as the main enzyme involved in the degradation of insulin and other amyloidogenic peptides, such as the β-amyloid (Aβ) peptide. Therefore, a role for the IDE in the cure of diabetes and Alzheimer's disease (AD) has been long envisaged. Anyway, its role in degrading amyloidogenic proteins remains not clearly defined and, more recently, novel non-proteolytic functions of the IDE have been proposed. From a structural point of view, the IDE presents an atypical clamshell structure, underscoring unique enigmatic enzymological properties. A better understanding of the structure-function relationship may contribute to solving some existing paradoxes of IDE biology and, in light of its multifunctional activity, might lead to novel therapeutic approaches.

Multi-Anticancer Activities of Phytoestrogens in Human Osteosarcoma

Phytoestrogens are plant-derived bioactive compounds with estrogen-like properties. Their potential health benefits, especially in cancer prevention and treatment, have been a subject of considerable research in the past decade. Phytoestrogens exert their effects, at least in part, through interactions with estrogen receptors (ERs), mimicking or inhibiting the actions of natural estrogens. Recently, there has been growing interest in exploring the impact of phytoestrogens on osteosarcoma (OS), a type of bone malignancy that primarily affects children and young adults and is currently presenting limited treatment options. Considering the critical role of the estrogen/ERs axis in bone development and growth, the modulation of ERs has emerged as a highly promising approach in the treatment of OS. This review provides an extensive overview of current literature on the effects of phytoestrogens on human OS models. It delves into the multiple mechanisms through which these molecules regulate the cell cycle, apoptosis, and key pathways implicated in the growth and progression of OS, including ER signaling. Moreover, potential interactions between phytoestrogens and conventional chemotherapy agents commonly used in OS treatment will be examined. Understanding the impact of these compounds in OS holds great promise for developing novel therapeutic approaches that can augment current OS treatment modalities.

Deep brain stimulation for autism spectrum disorder

Deep brain stimulation (DBS) is a medical treatment that aims to obtain therapeutic effects by applying chronic electrical impulses in specific brain structures and neurological circuits. Over the years, DBS has been studied for the treatment of many psychiatric disorders. Scientific research on the use of DBS in people with autism has focused this interest mainly on treatment-resistant obsessive-compulsive disorder, drug-resistant epilepsy, self-injurious behaviors (SIB), and aggressive behaviors toward the self. Autism spectrum disorder (ASD) includes a group of developmental disabilities characterized by patterns of delay and deviance in the development of social, communicative, and cognitive skills and the presence of repetitive and stereotyped behaviors as well as restricted interests. People with autism often have numerous medical and psychiatric comorbidities that worsen the quality of life of patients and their caregivers. Obsessive-compulsive symptoms can be found in up to 81.3% of people with autism. They are often severe, refractory to treatment, and particularly difficult to treat. SIB has a high prevalence in severely retarded individuals and is often associated with autism. Drug treatment of both autism and SIB presents a therapeutic challenge. To describe the current state of the art regarding the efficacy of DBS in people with ASD, a literature search was conducted for relevant studies using the PubMed database. Thirteen studies have been considered in this paper. Up to date, DBS has been used for the stimulation of the nucleus accumbens, globus pallidus internus, anterior limb of the internal capsule, ventral anterior limb of the internal capsule, basolateral amygdala, ventral capsule and ventral striatum, medial forebrain bundle, and posterior hypothalamus. In the total sample of 16 patients, 4 were adolescents, and 12 were adults. All patients had symptoms resistant to multiple drug therapy. Many patients taken into consideration by the studies showed clinical improvements as evidenced by the scores of the psychopathological scales used. In some cases, clinical improvements have varied over time, which may require further investigation. Among the new therapeutic perspectives, DBS could be a valid option. However, further, and more in-depth research is needed in this field.

Cyclic Stretch-Induced Mechanical Stress Applied at 1 Hz Frequency Can Alter the Metastatic Potential Properties of SAOS-2 Osteosarcoma Cells

Recently, there has been an increasing focus on cellular morphology and mechanical behavior in order to gain a better understanding of the modulation of cell malignancy. This study used uniaxial-stretching technology to select a mechanical regimen able to elevate SAOS-2 cell migration, which is crucial in osteosarcoma cell pathology. Using confocal and atomic force microscopy, we demonstrated that a 24 h 0.5% cyclic elongation applied at 1 Hz induces morphological changes in cells. Following mechanical stimulation, the cell area enlarged, developing a more elongated shape, which disrupted the initial nuclear-to-cytoplasm ratio. The peripheral cell surface also increased its roughness. Cell-based biochemical assays and real-time PCR quantification showed that these morphologically induced changes are unrelated to the osteoblastic differentiative grade. Interestingly, two essential cell-motility properties in the modulation of the metastatic process changed following the 24 h 1 Hz mechanical stimulation. These were cell adhesion and cell migration, which, in fact, were dampened and enhanced, respectively. Notably, our results showed that the stretch-induced up-regulation of cell motility occurs through a mechanism that does not depend on matrix metalloproteinase (MMP) activity, while the inhibition of ion-stretch channels could counteract it. Overall, our results suggest that further research on mechanobiology could represent an alternative approach for the identification of novel molecular targets of osteosarcoma cell malignancy.

Active breaks: a strategy to counteract sedentary behaviors for Health Promoting Schools. A discussion on their implementation in Italy

Abstract

School Active Breaks are short bouts of physical activity (5-15 minutes) conducted by appropriately trained teachers and delivered during or between curricular lessons. They are a good strategy to counteract sedentary behaviors, and a growing body of evidence shows that they can represent also a tool to promote and improve health, school wellbeing and academic achievements. On 19 February 2022, the Working Group on Movement Sciences for Health of the Italian Society of Hygiene, Preventive Medicine and Public Health organized an Awareness Day on the effectiveness, usefulness and feasibility of School Active Breaks, opened to teachers, educators, school leaders, pediatricians, personnel from Departments of Prevention and Public Health and Health Policy-makers. During the event, the testimonies about the experiences already carried out in Italy showed that School Active Breaks are an effective intervention that each school can easily include in its educational offer and apply in any context.

Evaluation of an integrated physical activity program for pregnant women: WELL-DONE! Study

Background

Regular practice of physical activity (PA) during pregnancy has benefits for maternal and fetal health. Therefore, pregnant women (PW) should practice at least 150 minutes of moderate PA per week following the WHO guidelines. The aim of the study is to evaluate the effect of an adapted physical activity (APA) intervention for PW, to be included in childbirth preparation classes (CPCs) in terms of levels of PA, quality of life, physical performance, self-efficacy, sleep quality and anxious-depressive states.

Methods

The WELL-DONE! Study is a quasi-experimental study conducted with pregnant women at St. Orsola hospital, Bologna. We compared an experimental group (EG) with a control group (CG). EG attended 1hour/week session of APA during the usual CPCs for a 6 weeks period, while the CG received a one hour lesson about PA recommendation in pregnancy. The pre-post evaluation was carried out through questionnaires and motor tests, to which PW were subjected at baseline (T0), after the intervention (T1) and 3 months after delivery (T2). We used the Pregnancy Physical Activity Questionnaire (PPAQ) to collect data regarding PA levels and sedentary behavior.

Results

A sample of 50 pregnant women aged between 29-46 (mean age=35.44±3.99) was involved in the study (39 CG, 11 EG). After the intervention, PPAQ sedentary activity score was reduced in the EG group (-10.20±24.12) while remaining similar in the CG (0.58±22.65) without statistically significant differences between groups.

Conclusions

Preliminary results of the study show a reduced sedentary time in PW, highlighting a positive trend in the EG. This data underlines that incorporating APA in the CPCs can be an effective and safe strategy. Nevertheless, further analysis must be needed to find out if this trend can be observed in light PA, in the moderate and vigorous one.

Key messages

• Physical activity during pregnancy is a valuable tool for improving both mother and child well-being.

• Physical activity interventions, implemented in CPCs, seem useful in order to raise awareness about PA importance and reduce sedentarism in PW.

Designing active breaks in secondary school, results from focus group with teachers: the brave study

Background

Many adolescents are unable to accomplish the daily 60 minutes of moderate to vigorous physical activity (PA) recommended by WHO. Secondary school is a critical period for developing healthy habits and PA interventions have the potential to promote healthy development. Active Breaks (ABs) are a school-based intervention consisting of short bursts (5-15 minutes) of PA made part of the academic routine. Primary school has been ABs main setting, while secondary school interventions received less attention. The aim of the BRAVE Study is to investigate teachers’ opinion about the feasibility of ABs in Italian secondary school.

Methods

In November 2020 20 teachers from two secondary schools located in Bologna province (Italy) were enrolled in two focus groups (FGs). FGs were held online, recorded, and transcribed. Questions were asked about the role of PA in the school routine and related experiences, perceived barriers and facilitators of the intervention, suggestions regarding the intervention design. Final expectations were then discussed.

Results

Despite limited experience with PA interventions, participants felt ABs would improve psycho-physical well-being for both students and teachers. Lack of time and space and a wary attitude towards ABs were listed as barriers. Program flexibility regarding content, administration time frames and implementation mode was listed as a great facilitator: program should be adaptable to participants’ needs, favoring easy and quick exercises. Overall, expectations emphasized improving classroom behavior and promoting healthy habits.

Conclusions

Teachers felt that inclusion of ABs in secondary school was promising and could lead to many health benefits. ABs were deemed feasible given their short duration and adaptability, since the program can be implemented with current personnel resources and space configurations. Co-design is essential to overcome personal barriers and create an effective and sustainable intervention.

Key messages

• According to secondary school teachers, PA interventions have the potential to improve psycho-physical well-being and classroom environment, promoting healthy habits among students.

• ABs are deemed as a feasible and sustainable PA intervention thanks to program flexibility regarding contents, administration time frames and implementation mode.

Erasmus+sport let’s move Europa: learning units for health promotion among children and adolescents

Background

School years are crucial for acquiring life-lasting healthy habits. However, an increasing rate of children and adolescents fail to maintain a healthy lifestyle. European Union has financed the Erasmus+ Sport Let’s Move Europa project to design an innovative digital tool for promoting healthy lifestyles among those age groups. University of Bologna, partner of the project, has developed 30 Learning Units (LUs) about Physical Activity, Sleep and Nutrition to be integrated in the school program by teachers.

Methods

A group of 17 teachers (15 females and 2 males, mean SD age 49,5 ±11,6) from primary and secondary schools located in Bologna province (Italy) took part in semi-structured focus groups (FGs). The investigation focused on facilitators/barriers of the intervention and possible solutions, identifying time frames and locations, suggestions for engaging the different stakeholders (teachers, students and families). All FGs were recorded, transcribed, anonymized, and analyzed through inductive thematic analysis.

Results

30 LUs were created based on the latest scientific evidence and the FGs output. Each LU addresses a specific topic and is tailored differently for primary and secondary school. The layout includes an investigation on the topic, classroom activities, and a section about “healthy homework” or “challenges” to be accomplished at home, engaging families in the construction of a healthy routine. All the activities were designed to be feasible and sustainable. Each LU includes a discussion phase to understand students’ feedback about proposed homework and learning content.

Conclusions

FGs have proven crucial to tailoring LUs on the needs of different stakeholders and co-designing an effective intervention. “Healthy homework” and “Challenges” encourage students to pursue healthy habits also outside the school setting, involving families. Feedback on the activity provides an insight into the progression and effectiveness of the intervention.

Key messages

• The EUmove project integrates knowledge about sleeping, nutritional and physical activity habits into the school curriculum to promote healthy lifestyles among students and their families.

• Thanks to the FGs, LUs are designed to suit the target audience. LUs integration into school curricula is therefore a feasible intervention, not requiring specialized personnel to be implemented.

The Brave study: promoting active breaks in secondary school from students’ point of view

Background

According to the WHO recommendations, children and adolescents should perform at least 60 minutes per day of moderate to vigorous physical activity (PA). Active Breaks (ABs) interventions, short physical activity breaks of 5-15 minutes during school hours, have been examined in primary school children as a potential strategy to counteract a sedentary lifestyle, with minimal disruption to school learning activities. The aim of the BRAVE STUDY is to investigate the feasibility of ABs in a secondary school setting from the students’ point of view.

Methods

In December 2020, 10 students (age 12-13, 6 females and 4 males) attending the second and third grade of secondary schools located in Bologna province (Italy) were involved in a focus group (FG). The FG was conducted online because of COVID-19 and the answers transcribed for a later analysis. Students’ opinions were probed on the role of PA in school and possible facilitators/barriers to implementation of ABs in the school.

Results

Students reported they wanted to be more active as a consequence of time spent in class sitting at a desk. Students also reported that an organized activity like ABs conducted in the classroom setting provides an excellent opportunity to improve social relations with classmates. Students also highlighted the possible psycho-physical well-being benefits arising from PA. Among the potentially negative aspects reported, students underlined the possible confusion that would be created in classroom and the time subtracted from academic learning activities.

Conclusions

The FG represents an ideal mean to obtain in-depth information on how people feel about a pending program or a change in their routine. The current FG reinforces positive outcomes from exposure to a PA program that can be intertwined with their daily classroom activities. ABs programs can help to reconcile the needs of students that arise during the day with the PA objectives recommended by the WHO.

Key messages

• ABs can be a zero-cost intervention strategy to achieve WHO recommendations and would create conditions for a greater psycho-physical benefits in classrooms.

• A qualitative approach, such as FGs, provides a mean to collect information not obtainable with quantitative methods, that could be useful to co-design interventions for children and adolescents.

The effect of active breaks on cognitive performance and classroom behaviour: the I-move study

Background

Active Breaks (ABs) intervention involves short bouts of moderate to vigorous physical activity (MVPA) conducted during or between curricular lessons by the appropriately trained teachers. The aim of the Imola Active Breaks Study (I-MOVE study) was to evaluate the effect of an ABs intervention on cognitive function and classroom behaviour in primary school children.

Methods

The study was quasi-experimental, and it involved two groups attending a primary school in Imola (Bologna, Italy). The Active Breaks group (ABsG) performed the I-MOVE protocol consisting in 10 minutes of ABs divided in warm up, tone-up with high intensity interval training and cool-down. This is repeated three times a day for one year and half. The control group (CG) continued with regular lessons. The baseline assessment was conducted in October 2019 and the follow-up in May 2021. Cognitive performance was assessed using working memory test and classroom behaviour was monitored using an “ad hoc questionnaire”.

Results

Working memory performance increased significantly more in the ABsG (change: 1.30±1.17) than in CG (0.96±1.20), p < 0.05. Almost the entire sample of the children wanted to continue with this intervention in the next following year. Children reported improvements in their school-life quality, including feeling better in class (75.40%) and in school (82.50%) when using ABs. Improvements were also reported in children time-on-task behaviours: 52.90% said they work easily in class, 52.90% that they could listen more clearly, 58.80% reported they can stay seated easily, and 59.60% that they learned better and were more focused after ABs.

Conclusions

In conclusion the program has proven to be very effective on the children's cognitive improvement and classroom behaviour. Since the ABs intervention demonstrates these positive effects, its implementation in schools can have a beneficial, sustainable and long-term impact on childhood health.

Key messages

• ABs intervention represents a cost-effective strategy to be implemented in the school settings regardless of the age and sex differences, to make the school a more dynamic environment.

• Despite the pandemic difficulties, the ABs intervention proved to be sustainable, and to have a positive effect on classroom behaviour by improving children’s concentration and attention in class.

i-ECO: a novel method for the analysis and visualization of fMRI results in Psychiatry

Introduction

The high technical barrier to entry in the field of neuroimaging can hinder early insight from promising results and the development of evidence-based clinical practice.

Objectives

The working group focused on published literature in order to develop a new methodology in the analysis, visualization, and representation of fMRI data in the psychiatric setting.

Methods

Three valid and established measures were chosen, in order to achieve dimensionality reduction, stability and explainability of results, namely Regional-Homogeneity; fractional Amplitude of Low-Frequency Fluctuations; Eigenvector-Centrality. Each measure was color coded and individual images per subject compiled, averaging results by functional networks as described the FIND lab of the University of Stanford. 272 individual scans were processed (130 neurotypicals, 50 patients with Schizophrenia, 49 with Bipolar Disorder, 43 with ADHD).

Results

The discriminative power between clinical groups of the novel method was significant both by human eye, and later confirmation by statistical tests, and by computer vision algorithms (Convolutional Neural Networks). The precision-recall Area Under the Curve, dividing by 80/20 proportion between train and test sets, was >84.5% for each group. The group of patients with Bipolar Disorder showed a partial overlap with the group of patients suffering from Schizophrenia – by a dominance of Eigenvector-Centrality and Regional-Homogeneity, as well as a lower prevalence of fractional Amplitude of Low-Frequency Fluctuations, for both in comparison to controls.

Conclusions

The present study offers preliminary evidence for the adoption of i-ECO (integrated-Explainability through Color Coding) in fMRI analyses during rest in the Psychiatric field.

Disclosure

No significant relationships.

Parents’ perception of overweight-obese children Quality of Life in different settings

Background

Children's Health-Related Quality of Life (HRQoL) has been frequently investigated, in particular among individuals affected by chronic diseases. It is reported that agreement between child and parent ratings regarding the child's HRQoL is strongly influenced by the latter's health status. To our knowledge, there is no evidence of how this agreement is related to different healthcare settings. Thus, our study aims to examine the relationship between child's and parent-proxy reported HRQoL of similar overweight/obese children according to the recruitment setting.

Methods

A cross-sectional study was conducted among 68 overweight/obese children, aged 6-10, recruited in a primary school (Group1, G1) and in a hospital outpatient clinic (Group2, G2) of Imola (Italy) in 2019. HRQoL was assessed using Italian version 4.0 of the Pediatric Quality of Life (PedsQL) questionnaire. For each child, we obtained self-reported children's and parents' perceived children's HRQoL total score (5 questions investigating Physical Health domain and 10 questions investigating Psychosocial Health domain divided in Emotional, Social and School Functioning).

Results

In G1 there were n = 42 overweight/obese children and in G2 n = 26. The correlation between children's reported and parents' perceived HRQoL scores is lower in G1 (Physical Health: r=-0,17; Psychosocial Health: r = 0.38) compared to G2 (Physical Health: r = 0.80; Psychosocial Health: r = 0.66). Notably, in G1, parents tend to overestimate their children's HRQoL, specifically in the Physical Health domain.

Conclusions

Correlation between children's and parents' HRQoL scores is higher in the clinical setting compared to the school setting. Implementing this questionnaire on a large scale would allow us to identify settings which need awareness-raising initiatives to improve parents' knowledge about their children's health.

Key messages

Parents’ overestimate children’s HRQoL in the school setting, particularly in the Physical Health domain. Children’s HRQoL misinterpretation might determine less targeted actions to improve their wellbeing and highlights the need for raising parents’ awareness about obesity and its effects on children.

Does parents’ educational level affect children's sedentary behaviour? A cross sectional analysis

Background

Evidence links sedentary behaviours (SB) with poorer health outcomes; i.e. higher screen time is associated with poorer fitness and cardiometabolic health, as well as unfavourable measures of adiposity, mental health and social behaviour in children. The WHO guidelines for children recommend reaching at least an average of 60 min per day of physical activity (PA). Several studies show a correlation between parental education (PE) and children PA levels. This study aims to analyse the influence that PE has on childrens' sedentary lifestyle and PA habits in Italian society.

Methods

We conducted a cross-sectional analysis among 428 children aged 6-11 recruited in a primary school of Calderara di Reno (Italy) in 2017. Children's and parents' information were collected at baseline (i.e. age, BMI, occupation, instruction). PA level and SB were evaluated using a weekly diary investigating screen time (PC and TV), sports practice and active play (i.e: running, jumping, riding a bike, etc.). We investigated the relationship between lifestyles and PE (high school degree or lower vs college degree or higher) through multiple linear regression models adjusted for age and gender.

Results

Our models show that fathers' educational level is not related to children's SB. PA habits and weekly sports activities are not related to PE. On the other hand, higher mothers' educational level shows to be linked to a decreased TV screen time (p = 0.003) and time spent using a computer (p = 0.035). Notably, older children spend more time using PCs or devices (p = 0.001), net of confounding variables.

Conclusions

Our findings show that mothers' educational level positively influences children's lifestyle. This result might be related to the fact that, in the Italian context, mothers are usually the principal children's caregiver influencing their daily routine. In light of this, mothers might be considered a primary target when implementing public health interventions to reduce children's SB.

Key messages

Higher mothers’ educational level is positively associated with healthier lifestyles in children, in particular in determining a less sedentary behaviour. Fathers' degree of education does not display any impact on children's attitude toward sports and PA.

Exploring children breakfast habits using Zoom8-questionnaire: Results from the I-MOVE Study

Background

Scientific evidence widely argues that consuming breakfast daily is considered a good habit which positively affects health and academic performance, especially in children. In order to be adequate, according to national requirements, breakfast should include a portion of milk or yogurt and one grain based product, providing about 15-20% of the daily recommended energy intake. The aim of this study was to analyse breakfast habits in a convenience sample of primary school children inside the Imola Active Breaks Study.

Methods

A cross-sectional study was conducted in a sample of children, aged 6-10, recruited in a primary school of Imola (Emilia Romagna region, Italy). The Zoom8 self-reported questionnaire, which investigates dietary habits and lifestyle aspects were administered to parents to explore the children's breakfast habits.

Results

A total of 155 children were recruited in November 2019. Breakfast was consumed daily by 117 children (75%), 4-6 times/week by 12 (7%), 2-4 times/week by 4 (3%), and 22 (14%) did not answer. Concerning dairy products' consumption: 50 (32%) children reported milk or yogurt, 47 (30%) milk, 6 (4%) yogurt, 9 (6%) neither of them and 43 (28%) gave no answer. Mostly all the children consumed at least one of these products: biscuits, cakes, croissants, industrial snacks or cereals. 108 children (70%) recognised that the consumption of a dairy and a carbohydrate product represent an adequate breakfast.

Conclusions

The findings suggested that the majority of children consumed one grain based product for breakfast, but most of them were high in sugar and fat content (industrial snacks and croissants). Still not every child had breakfast daily nor had a portion of a dairy product. Measurements should be taken to avoid skipping breakfast and to promote a more balanced breakfast. It would be advisable to analyse in detail the frequency of consumption of each food group and their energy intake.

Key messages

Breakfast consumption positively affects children’s health and academic performance. Health Promotion should stimulate daily consumption of breakfast and improve its quality and energy intake.

Association between parents’ education level and KIDMED index: a cross-sectional study

Background

Mediterranean diet (MD) is considered a healthy dietary model with several beneficial effects.

A strict adherence to the MD in children, coupled with daily exercise, can prevent obesity and significantly reduce the risk of correlated chronic diseases, such metabolic syndrome. The aim of this study is to evaluate the association between parents' educational level and compliance to the MD in a convenience sample of Italian children.

Methods

We conducted a cross-sectional study among 428 children aged 6-11 recruited in a primary school of Calderara di Reno (Italy) between May and June of 2017. Children's and parents' information were collected at baseline (i.e. age, BMI, occupation, educational level). A weekly food diary was administered to evaluate the participant's dietary habits. The degree of adherence to MD was derived from these diaries using the KIDMED index developed in 2003 by Serra-Majem et al. We used multiple linear regression models, adjusted for age and gender, to investigate how parents' educational level affected children's KIDMED index.

Results

Adherence to the MD was high, medium and poor in, respectively, 4%, 60% and 36% of children. Higher prevalence of overweight and obesity was observed among those with lower adherence to the MD. The linear regression model shows that fathers' educational level is not associated to children's KIDMED index variation. On the other hand, a higher mothers' educational level is linked to an increased weekly KIDMED index (p = 0.012) as well as an increased weekend KIDMED index (p = 0.048).

Conclusions

Mothers' education level is associated with increased adherence to MD, both weekly and weekend. The greater difference has been observed during weekend, when children of highly educated mothers score higher at KIDMED index.

Key messages

Mothers’ educational level plays an important role in children’s eating habits, with higher educational level associated with a better adherence to the MD. It is critical to implement parents' toolkit to promote healthy dietary patterns and adherence to MD in order to correct these social differences.

Meals adequacy during weekdays and weekends in an Italian primary school children sample

Background

Between 15 and 50% of European children aged 6-9 are overweight or obese and this number is rising dramatically over time, making it one of the most important public health challenges. Selection of healthy food and a balanced diet are key when addressing this obesity epidemic. At the same time, it is essential to consider schools' role and parents' influence on children's dietary habits. This study aims to assess the adequacy of meals during the weekdays (WD) and weekends (WE), therefore highlighting the critical moments where schools' and parents' involvement needs to be of greater impact.

Methods

A cross-sectional study was conducted among 428 children aged 6-11 recruited in a primary school of Calderara di Reno (Italy) in 2017. A weekly diary was administered between May and June 2017 to explore the dietary habits of the participants. Every day for each meal (breakfast, morning snack, lunch, dinner) it was required to report what types of food and beverages were consumed, and where (home/school). The adequacy of each meal was determined by using national guidelines. A McNemar test was performed to evaluate the differences in meal adequacy between the WD and WE.

Results

Our analysis showed that meals consumed at school, i.e. morning snacks and lunches, were more adequate during WD than WE (69.6% vs 22.2%, 53.5% vs 32.5%; P-value <0.001), underlying the positive influence of school. On the other hand, breakfasts and dinners were more adequate during WE than WD (64.5% vs 51.4%, 23.8% vs 15.7%; P-value <0.001); this difference might be partially explained by the different amount of time parents have for food preparation during workdays versus weekends.

Conclusions

Further preventive interventions should address childrens' and parents' home dietary routine as a tool to improve meal adequacy at home and therefore reduce childhood obesity. Parental school-based interventions could have a key role in changing childrens' dietary habits.

Key messages

Our study showed a significant difference of healthy dietary habits between meals served at school during weekdays and at home during weekends, highlighting a higher dietary adequacy in the first ones. The results underline the importance of implementing educational programs addressing childrens’ and their parents' home meals routine and dietary habits.

Pregnant women and midwives’ perception regarding physical activity recommendation during pregnancy

Introduction

Physical activity (PA) is a modifiable lifestyle factor which contributes to improve pregnancy and perinatal outcomes. Therefore, pregnant women (PW) without contraindications should practice 150 minutes of moderate PA per week, according to the World Health Organization (WHO) guidelines. Nevertheless, a reduction of PA throughout the gestational period appears to be worryingly common. The aim of this survey was to analyse the feasibility of the WHO recommendations, investigating PW and midwives' perceptions towards PA during pregnancy, in a view to enhance future PA interventions.

Methods

A total number of 4 focus groups, involving 10 midwives (aged 43-61) and 10 PW (aged 30-46), recruited at the University Hospital of Bologna, were carried out between July 2020 and April 2021. Due to SARS-CoV-2 restrictions, all meetings were held online, recorded, transcribed and then analysed using the COM-B model.

Results

WHO recommendations were deemed feasible by both midwives and PW when time management skills and capabilities to adapt PA to individual needs were present. Clearly, women with a background in PA practice tend to be highly motivated thereby maintaining the PA routine also during pregnancy. Both groups reported that PA represents a positive element for the mother's and baby's well-being, triggering a virtuous circle and increasing motivation. Being able to access and perform simple, structured, evidence-based activities, family support, and using every opportunity to be less sedentary were reported as key aspects amongst opportunities to improve PA levels.

Conclusions

Positive perception regarding feasibility of the recommendations was similar between groups; nevertheless, midwives perceived pregnancy as an opportunity to change PA routines, while PW considered pregnancy a less dynamic period. Therefore, implementing PA promotion involving midwives might represent a good strategy given their central role during this woman' unique period.

Key messages

WHO physical activity recommendations are overall deemed feasible, but tailored opportunities and strategies tackling everyday obstacles and lack of information need to be provided.

Enhancing PA is a key challenge for pregnant women in a view of their own and baby's health. The COM-B model can be used to implement new strategies involving midwives to reach the goal.

Preliminary data on physical well-being of children and adolescents during the SARS-CoV-2 pandemic

Background

The COVID-19 outbreak has forcibly overshadowed the physical well-being of children and adolescents, of which we will see the consequences in near future. The programs to contain the spread of Sars-CoV-2 resulted in prolonged lockdown periods, discontinuity of educational services and a possible decrease in physical activities (PA) among the youngest. In the local reality of the Metropolitan City of Bologna children and adolescents underwent a radical change in habits and lifestyle, overall predisposing sedentariness and unhealthy behaviors. Our project, “Come te la passi?”, aims to acknowledge lifestyle variations (concerning diet, PA, sleep behavior/quality) to design, in second-phase interventions, individualized school-based educational programs.

Methods

This ongoing study is being conducted using an on-line anonymous questionnaire targeting parents/guardian of children and adolescents aged 6-17 recruited from 26th to 28th of April in Bologna, a city in Northern Italy.

Results

Preliminary data suggested that among adolescents (n = 124) 91.2% used to do PA 2 or more times a week before lockdown, while during lockdown this percentage decreased, reaching 41.1%. In children (n = 38) we observed an even more pronounced difference, with PA decreasing from 89.5% to 26.3%. In children 29% of the participants also reported a weight gain, while 65.8% did not report any variation and only 5.2% reported a weight loss. For the majority of both children's and adolescents' parents (n = 162), the strategies to address the reduction in PA were predominantly having school time dedicated only to PA (53.1%) and being more educated about simple physical exercises (14.5%).

Conclusions

Our preliminary findings suggest that the current pandemic had a strong impact on the well-being of children and adolescents; “Come te la passi?” second-phase interventions could be crucial in addressing the youngest' needs, to educate and promote healthier lifestyles through school-based programs.

Key messages

Children’s and adolescents’ lifestyle behaviors were strongly affected by the current pandemic, with physical activity frequency more than halved.

“Come te la passi?” objectives are to frame the major critical issues detected and to shape educational school programs based on identified needs.

At the Cutting Edge against Cancer: A Perspective on Immunoproteasome and Immune Checkpoints Modulation as a Potential Therapeutic Intervention

Immunoproteasome is a noncanonical form of proteasome with enzymological properties optimized for the generation of antigenic peptides presented in complex with class I MHC molecules. This enzymatic property makes the modulation of its activity a promising area of research. Nevertheless, immunotherapy has emerged as a front-line treatment of advanced/metastatic tumors providing outstanding improvement of life expectancy, even though not all patients achieve a long-lasting clinical benefit. To enhance the efficacy of the currently available immunotherapies and enable the development of new strategies, a broader knowledge of the dynamics of antigen repertoire processing by cancer cells is needed. Therefore, a better understanding of the role of immunoproteasome in antigen processing and of the therapeutic implication of its modulation is mandatory. Studies on the potential crosstalk between proteasome modulators and immune checkpoint inhibitors could provide novel perspectives and an unexplored treatment option for a variety of cancers.

Sharing own story telling during COVID-19’s italian lockdown: An experience with schizophrenic outpatients

Introduction

Affective flattening is one of the main symptoms in Schizophrenia, several studies highlighted the importance of social skills training in improving negative symptoms. However, Covid-19 pandemic is changing our life with limitations in social contacts and in psychosocial rehabilitation; pre COVID-19 strategies should be implemented with new ones.

Objectives

To evaluate the practicability of a narrative method in improving affective flattening, general social skills in stable outpatients with a diagnosis for schizophrenia during Italian lockdown in March – April 2020

Methods

Outpatients with a stable psychopathology have been involved in a narrative project during lockdown. We asked to patients to write daily a story telling about their experience and emotions and send us their diary. Every week the diary has been used to discuss their story telling in group in a web conference. At end of the experience we administered a survey about the enjoyment and the subjective benefits.

Results

From ten people with a known psychopathology we recruited six patients. All participants completed the project and all of them referred for a subjective benefit as to feel more reassured by the contact with their psychiatrist. Four patients explicated initial discomfort about share their experiences in group. One patient started to share his own thoughts about mental disease on social media.

Conclusions

Narrative Psychiatry might be a pragmatic opportunity to implement conventional strategies to contrast affective flattening and negative symptoms in Schizophrenia. Sharing digital story telling is a useful method in lockdown and general social restriction condition.

Lurasidone treatment in a delusional disorder patient with atrial fibrillation: A case report

Introduction

Psychosis itself may be associated with an increased risk of atrial fibrillation. Moreover, antipscyhotic treatment increases this risk. Recently D’Urso et al. reported aripiprazole-induced atrial fibrillation in a patient with concomitant risk factors.

Objectives

To the best of author’s knowledge no data has been published about the safety and the efficacy of lurasidone treatment in psychotic patient with comorbid atrial fibrillation.

Methods

A 68 years old patient with persistent atrial fibrillation and hypertension in treatment with amiodarone 100 mg/day, lurasidone 25 mg/day, rivaroxaban 15 mg/day, clopidogrel 75 mg/day, bisoprolol 1,25 mg/day, tamsulosin 0,4 mg/day presented delusional ideas of jealousy for not real betrayal by his wife, social withdrawal, reduced sleep. Blood pressure 130/80 mmHg, heart rate 70 bpm, Qtc 420 msec. The patient was drug-naïve for any psychotropic treatment. The authors decided to start lurasidone treatment at the dosage of 18,5 mg/day.

Results

After the first administration of lurasidone treatment sleep was resolved. After two weeks delusional ideas and social withdrawal were markedly improved. After one month of treatment, blood pressure, heart rate and Qtc remained almost stable. The authors decided not to increase the dosage of lurasidone because of the age of the patient and the comorbid cardiovascular pathologies.

Conclusions

Lurasidone has showed safety and efficacy in the treatment of this patient with delusional disorder and comorbid atrial fibrillation. This is a preliminary data that requires follow up and further studies to confirm the usefulness of lurasidone in psychotic patients with atrial fibrillation and cardiovascular risks.

Disclosure

No significant relationships.

Ultrashort high energy electron bunches from tunable surface plasma waves driven with laser wavefront rotation

We propose to use ultrahigh intensity laser pulses with wave-front rotation (WFR) to produce short, ultraintense surface plasma waves (SPW) on grating targets for electron acceleration. Combining a smart grating design with optimal WFR conditions identified through simple analytical modeling and particle-in-cell simulation allows us to decrease the SPW duration (down to a few optical cycles) and increase its peak amplitude. In the relativistic regime, for Iλ_{0}^{2}=3.4×10^{19}W/cm^{2}μm^{2}, such SPW are found to accelerate high charge (few 10 s of pC), high energy (up to 70 MeV), and ultrashort (few fs) electron bunches.

Oxygen-ozone therapy as adjuvant in the current emergency in SARS-COV-2 infection: a clinical study

The aim of the multicentre study promoted by Nuova FIO is to evaluate the beneficial effects of the systemic Oxygen-Ozone (O2O3) therapy in patients suffering from SARS COV-2 disease in the early phases of the disease, before worsening, up to the need of tracheal intubation. The study is based on the rationale on that the systemic oxygen-ozone treatment could be effective, positively influencing the disease evolution and/or being able to mitigate the onset of the cytokine storm syndrome at least partially.

The proteasome as a druggable target with multiple therapeutic potentialities: Cutting and non-cutting edges

Ubiquitin Proteasome System (UPS) is an adaptable and finely tuned system that sustains proteostasis network under a large variety of physiopathological conditions. Its dysregulation is often associated with the onset and progression of human diseases; hence, UPS modulation has emerged as a promising new avenue for the development of treatments of several relevant pathologies, such as cancer and neurodegeneration. The clinical interest in proteasome inhibition has considerably increased after the FDA approval in 2003 of bortezomib for relapsed/refractory multiple myeloma, which is now used in the front-line setting. Thereafter, two other proteasome inhibitors (carfilzomib and ixazomib), designed to overcome resistance to bortezomib, have been approved for treatment-experienced patients, and a variety of novel inhibitors are currently under preclinical and clinical investigation not only for haematological malignancies but also for solid tumours. However, since UPS collapse leads to toxic misfolded proteins accumulation, proteasome is attracting even more interest as a target for the care of neurodegenerative diseases, which are sustained by UPS impairment. Thus, conceptually, proteasome activation represents an innovative and largely unexplored target for drug development. According to a multidisciplinary approach, spanning from chemistry, biochemistry, molecular biology to pharmacology, this review will summarize the most recent available literature regarding different aspects of proteasome biology, focusing on structure, function and regulation of proteasome in physiological and pathological processes, mostly cancer and neurodegenerative diseases, connecting biochemical features and clinical studies of proteasome targeting drugs.

The role of the trainer in adapted physical activity for osteoporosis to improve quality of life

Background

Osteoporosis is a major health burden worldwide and require a multi-modal approach including exercise. Fractures have a substantial impact on quality of life (QoL) so exercise programs may to be conducted by trainers able to deal with this condition, because exercise alone, even if in the right dosage, seems to be not enough to improve QoL. A quasi-experimental pilot study performed to determine the feasibility and safety of an Adapted Physical Activity (APA) protocol specifically designed for osteoporotic women with vertebral fractures and its effect on QoL, with a specific focus on trainer's role.

Methods

The Experimental Group (EG) performed APA protocol 1hour twice a week for 6 months, while the Control Group (CG) received standard care. QoL was assessed at baseline and follow-up with ECOS-16 questionnaire and semi structured interviews to understand women perceptions regarding trainer's role. Using mixed-methods quantitative and qualitative data were analyzed using SPSS 5 and NVivo 12, respectively.

Results

40 post-menopausal women (mean age: 67.6±4.6) divided in 2 groups EG = 22 and CG = 18, completed the study. At follow-up, EG improved significantly QoL (EG: -0.5±0.5 vs CG: 0.0±0.3 p = 0.02). The APA intervention had a significant effect on all the components of QoL, as measured by the disease-specific ECOS-16 questionnaire: Physical Component Summary (PCS) (EG: -0.4±0.5 vs CG: 0.0±0.4 p = 0.06) and Mental Component Summary (MCS) (EG: -0.5±0.6 vs CG: 0.1±0.5 p = 0.02). The interviews confirmed this result, emphasizing the key role of the trainer in improving their QoL. The adherence calculated as number of sessions performed compared to the sessions proposed was 75.8%. No injuries were observed.

Conclusions

The feasibility, the safety, and the positive effect of the proposed exercise protocol on QoL confirmed also by the interviews, show that principles of exercise education applied by trainers should be extended also to patients with other chronic condition.

Key messages

Trainers specifically educated, could be a means of achieving the goal improving people’s QoL, as they occupy the role of exercise experts and also an educational, relational and support role. The management of osteoporosis is multi-modal and includes exercise, often recommended as a beneficial non-pharmacological treatment to slow the rate of bone loss and improve quality of life.

Health impact of an intervention sport-competition-based in elderly: the “In-Common sport” project

Background

The health benefits of a regular physical activity (PA) in older people are well known but the majority of older people in Europe do not meet the recommended levels to maintain health. How to promote a regular PA in elderly is a responsibility and a challenge for Local Authorities. “IN COMMON SPORTS-Intergenerational Competition As Motivation For Sport And Healthy Lifestyle Of Senior Citizens” is a three year Erasmus+ Sport project which promotes active lifestyle in senior citizens bringing them closer to sport activities. The project involved five countries: Portugal, Italy, Spain, Bulgaria and Hungary. The aim of the study is to present one-year follow-up data of the Italian sample.

Methods

Quasi-experimental study with 121 participants over 60-aged recruited in Cesena (Italy) through newspaper advertising. The experimental group (EG) attended twice a week structured training sessions for two years. Sessions included aerobic activity of moderate intensity and muscle-strengthening activities interspersed with aerobic activity of vigorous intensity. The training was the basis for the preparation in a competition that took place in each country. The control group (CG) received the advice to practice regular PA. Upper limb muscle strength (Handgrip Test) was measured as primary outcome.

Results

One year follow-up analysis were conducted on 76 participants, 52 in EG and 24 in CG (mean age: 71±6.7) using ANOVA and ANCOVA to test the effects of the intervention. The EG significantly improved upper limb muscle strength (1.9±2.8) vs CG significantly worsened (-1.9±3.5). After adjusted for unbalanced variables, the comparison between groups showed a significant effect of intervention on handgrip test (p value=0,012).

Conclusions

”IN COMMON SPORTS” project has significantly improved handgrip strength in Italian participants. This test has shown to be a proxy of decline in cognition, mobility, functional status and mortality in older community-dwelling populations.

Key messages

IN COMMON SPORTS promotes active lifestyle in senior citizens bringing them closer to sport activities. The project has proven to be effective in improving handgrip strength.

Comparison between health-related quality of life in normal-weight and overweight-obese children

Background

In Italy 32% of 6-10 aged children were overweight in 2017-2018. Measures of Health-Related Quality of Life (HRQoL) assess important aspects of health daily activities, physical symptoms, social interactions and emotional well-being. It is suggested that HRQoL is influenced by children's weight status. The aim of the study is to compare HRQoL among normal-underweight and overweight-obese children in an Italian sample.

Methods

A cross-sectional study was conducted in 2019 among 144 children, aged 6-10, recruited in a primary school in Bologna (Italy). Children were divided in Group1 (G1: normal-underweight) and Group2 (G2: overweight-obese) using the International Obesity Task Force cut points. HRQoL was assessed using 4.0 Italian version of PedsQL questionnaire. We obtained summary scores for children's total HRQoL and two subscales: one for physical health and one for emotional, social and school functioning.

Results

Of 144 children, 98 (68%) and 46 (32%) were respectively in G1 and G2. HRQoL total scores were 73.10±1.30 in G1 and 69.28±1.96 in G2 (p = 0.051). We analysed separately children in Grade 1 and Grade 3-4. In Grade 1, there were 68 children: 48 (71%) in G1 and 20 (29%) in G2. In grade 3-4 there were 76 children: 50 (66%) in G1 and 26 (34%) in G2. HRQoL total scores in grade 3-4 were: 73.28±1.63 in G1 and 72.66±2.32 in G2 (p = 0.41). In Grade 1, HRQoL total scores were 72.92±2.05 in G1 and 64.89±3.15 in G2 (p = 0.02); at subscale levels, means for physical health were 77.73±1.92 in G1 and 72.5±3.58 in G2 (p = 0.08) and means for emotional, social and school functioning were 70.35±2.48 in G1 and 60.83±4.04 in G2 (p = 0.02).

Conclusions

The effects of child overweight and obesity on health-related QOL was more evident in children aged 6-7, especially regarding emotional, social and school functioning. Prevention of childhood overweight and obesity is important not only to avoid health consequences of weight but also to improve children' quality of life.

Key messages

Overweight is a public health problem in Italy not only among adults, but even among children. Overweight has a negative impact on quality of life, therefore a healthy lifestyle should be promoted.

The Imola Active Breaks study: a new strategy in child public health to reduce sedentary

Background

Physical inactivity is worldwide considered one of the biggest public health problems of the 21st century. WHO recommended in children, at least 60 minute of Moderate Vigorous Physical activity (MVPA) per day, but low percentages comply with guidelines. Considering that children spend many hours at school, classroom is the ideal setting to increase their PA. Active Breaks (AB) are a 5-15-minute bouts of PA led by the teachers during academic lessons. The aim of the Imola AB study is to implement a 1-year intervention based on AB (10min/3per-day) in primary school as a new strategy to reduce inactivity. We present the baseline results.

Methods

Quasi-experimental pre-post study in 6-10aged primary school children, in Imola(Italy).We evaluated PA level with Actigraph accelerometers: time (in minutes) spent in MVPA Weekly and Daily (W-MVPA; D-MVPA) and Weekly Sedentary behaviours (W-SB).

Results

We recruited 152 children: N = 110 in Active Breaks experimental group (AB) and N = 42 in control group (CG). Actigraph's analysis showed that 42,5% of children in the ABG vs 31.0% in the CG reach the WHO recommendation (p=ns). We investigated baseline differences between groups using ANOVA dividing children by grade. In 3-4 grades: W-MVPA (AB = 318.3±15.5 vs CG = 310.4±98.0 p = 0.78); D-MVPA (AB = 53.0±20.3 vs CG = 51.8±16.3 p = 0.79);W-SB (AB = 6,687.5±375.3 vs CG = 6,754.7±281.0 p = 0.45). In 1grade: W-MVPA (AB = 376.1±127.9 vs CG = 300.3±120.0 p = 0.02); D-MVPA (AB = 62.7±21.3 vs CG = 50.0±20.0 p = 0.02); W-SB (AB = 6,436.0±496.0 vs CG = 6,373.3 ±1,532.0 p = 0.7).

Conclusions

Only the 39.2% of the total sample met the 60-minute/day of MVPA recommended. We found no significant baseline differences in PA level measured by Actigraph between CG and AB, excepted in 1 grade. The intervention implemented in the Imola AB study could be a good strategy to reduce sedentary in children and reach the WHO recommendation, thus contributing to the aims of the new Global Action Plan on PA 2018-2030.

Key messages

Less than 50% reach the WHO recommendations of PA. AB implemented in the Imola Study could be a public health school-based strategy to reduce sedentary and increase healthy behavior in children. Active breaks (AB) are emerging as a good strategy to increase the PA level, reducing the time in sedentary habits.

Exo-Ocean Exploration with Deep-Sea Sensor and Platform Technologies

One of Saturn's largest moons, Enceladus, possesses a vast extraterrestrial ocean (i.e., exo-ocean) that is increasingly becoming the hotspot of future research initiatives dedicated to the exploration of putative life. Here, a new bio-exploration concept design for Enceladus' exo-ocean is proposed, focusing on the potential presence of organisms across a wide range of sizes (i.e., from uni- to multicellular and animal-like), according to state-of-the-art sensor and robotic platform technologies used in terrestrial deep-sea research. In particular, we focus on combined direct and indirect life-detection capabilities, based on optoacoustic imaging and passive acoustics, as well as molecular approaches. Such biologically oriented sampling can be accompanied by concomitant geochemical and oceanographic measurements to provide data relevant to exo-ocean exploration and understanding. Finally, we describe how this multidisciplinary monitoring approach is currently enabled in terrestrial oceans through cabled (fixed) observatories and their related mobile multiparametric platforms (i.e., Autonomous Underwater and Remotely Operated Vehicles, as well as crawlers, rovers, and biomimetic robots) and how their modified design can be used for exo-ocean exploration.

Defective proteasome biogenesis into skin fibroblasts isolated from Rett syndrome subjects with MeCP2 non-sense mutations

Rett Syndrome (RTT) is a rare X-linked neurodevelopmental disorder which affects about 1: 10000 live births. In >95% of subjects RTT is caused by a mutation in Methyl-CpG binding protein-2 (MECP2) gene, which encodes for a transcription regulator with pleiotropic genetic/epigenetic activities. The molecular mechanisms underscoring the phenotypic alteration of RTT are largely unknown and this has impaired the development of therapeutic approaches to alleviate signs and symptoms during disease progression. A defective proteasome biogenesis into two skin primary fibroblasts isolated from RTT subjects harbouring non-sense (early-truncating) MeCP2 mutations (i.e., R190fs and R255X) is herewith reported. Proteasome is the proteolytic machinery of Ubiquitin Proteasome System (UPS), a pathway of overwhelming relevance for post-mitotic cells metabolism. Molecular, transcription and proteomic analyses indicate that MeCP2 mutations down-regulate the expression of one proteasome subunit, α7, and of two chaperones, PAC1 and PAC2, which bind each other in the earliest step of proteasome biogenesis. Furthermore, this molecular alteration recapitulates in neuron-like SH-SY5Y cells upon silencing of MeCP2 expression, envisaging a general significance of this transcription regulator in proteasome biogenesis.

Embolization of iliac metastasis during lenvatinib treatment in patient with advanced Hürthle cell thyroid carcinoma

Lenvatinib is a tyrosine kinase inhibitor (TKI) with antiproliferative and antiangiogenic effects indicated for the treatment of progressive, locally advanced or metastatic progressive thyroid carcinoma, refractory to radioactive iodine therapy. Antiangiogenic therapies induce ischemic necrosis of tumor tissue, with increased risk of hemorrhagic complications. The management of hemorrhagic risk is based on precautionary measures and for any surgical procedure, it is advised to interrupt the treatment in order to avoid complications. 'Flare-up' of tumor activity may follow TKI interruption. However, it is not known if continuing TKIs during minimally invasive interventions is safe. We report here the first case in which an embolization of metastasis is performed without interrupting lenvatinib treatment. The procedure was successful and free of complications.

On the Horizon: Targeting Next-Generation Immune Checkpoints for Cancer Treatment

BACKGROUND

Immune checkpoints are critical regulatory pathways of the immune system which finely tune the response to biological threats. Among them, the CD-28/CTLA-4 and PD-1/PD-L1 axes play a key role in tumour immune escape and are well-established targets of cancer immunotherapy.

SUMMARY

The clinical experience accumulated to date provides unequivocal evidence that anti-CTLA-4, PD-1, or PD-L1 monoclonal antibodies, used as monotherapy or in combination regimes, are effective in a variety of advanced/metastatic types of cancer, with improved clinical outcomes compared to conventional chemotherapy. However, the therapeutic success is currently restricted to a limited subset of patients and reliable predictive biomarkers are still lacking. Key Message: The identification and characterization of additional co-inhibitory pathways as novel pharmacological targets to improve the clinical response in refractory patients has led to the development of different immune checkpoint inhibitors, the activities of which are currently under investigation. In this review, we discuss recent literature data concerning the mechanisms of action of next-generation monoclonal antibodies targeting LAG-3, TIM-3, and TIGIT co-inhibitory molecules that are being explored in clinical trials, as single agents or in combination with other immune-stimulating agents.

Screening of asymptomatic rheumatic heart disease among refugee/migrant children and youths in Italy

BACKGROUND

Rheumatic heart disease (RHD) is a chronic condition responsible of congestive heart failure, stroke and arrhythmia. Almost eradicated in high-income countries (HIC), it persists in low- and middle-income countries. The purpose of the study was to assess the feasibility and meaningfulness of ultrasound-based RHD screening among the population of unaccompanied foreign minors in Italy and determine the burden of asymptomatic RHD among this discrete population.

METHODS

From February 2016 to January 2018, Médecins Sans Frontières conducted a weekly mobile screening by echocardiography in reception centers and family houses for unaccompanied foreign minors in Rome, followed by fix echocardiographic retesting for those resulting positive at screening. 'Definite' and 'borderline' cases were defined according to the World Hearth Federation criteria.

RESULTS

Six hundred fifty-three individuals (13-26 years old) were screened; 95.6% were below 18 years old (624/653). Six 'definite RHD' were identified at screening, yielding a detection rate of 9.2‰ (95% CI 4.1-20.3‰), while 285 (436.4‰) were defined as 'borderline' (95% CI 398.8-474.9‰). Out of 172 "non-negative borderline" cases available for being retested (113 "non-negative borderline" lost in follow-up), additional 11 were categorized as 'definite RHD', for a total of 17 'definite RHD', yielding a final prevalence of 26.0‰ (95% CI 16.2-41.5‰) (17/653), and 122 (122/653) were confirmed as 'borderline' (final prevalence of 186.8‰, 95% CI 158.7-218.7). In multivariate logistic regression analysis the presence of systolic murmur was a strong predictor for both 'borderline' (OR 4.3 [2.8-6.5]) and 'definite RHD' (OR 5.2 [1.7-15.2]), while no specific country/geographic area of origin was statistically associated with an increased risk of latent, asymptomatic RHD.

CONCLUSIONS

Screening for RHD among the unaccompanied migrant minors in Italy proved to be feasible. The burden of 'definite RHD' was similar to that identified in resource-poor settings, while the prevalence of 'borderline' cases was higher than reported in other studies. In view of these findings, the health system of high-income countries, hosting migrants and asylum seekers, are urged to adopt screening for RHD in particular among the silent and marginalized population of refugee and migrant children.

Patient similarity for precision medicine: A systematic review

Evidence-based medicine is the most prevalent paradigm adopted by physicians. Clinical practice guidelines typically define a set of recommendations together with eligibility criteria that restrict their applicability to a specific group of patients. The ever-growing size and availability of health-related data is currently challenging the broad definitions of guideline-defined patient groups. Precision medicine leverages on genetic, phenotypic, or psychosocial characteristics to provide precise identification of patient subsets for treatment targeting. Defining a patient similarity measure is thus an essential step to allow stratification of patients into clinically-meaningful subgroups. The present review investigates the use of patient similarity as a tool to enable precision medicine. 279 articles were analyzed along four dimensions: data types considered, clinical domains of application, data analysis methods, and translational stage of findings. Cancer-related research employing molecular profiling and standard data analysis techniques such as clustering constitute the majority of the retrieved studies. Chronic and psychiatric diseases follow as the second most represented clinical domains. Interestingly, almost one quarter of the studies analyzed presented a novel methodology, with the most advanced employing data integration strategies and being portable to different clinical domains. Integration of such techniques into decision support systems constitutes and interesting trend for future research.

Patient similarity by joint matrix trifactorization to identify subgroups in acute myeloid leukemia

Objective

Computing patients’ similarity is of great interest in precision oncology since it supports clustering and subgroup identification, eventually leading to tailored therapies. The availability of large amounts of biomedical data, characterized by large feature sets and sparse content, motivates the development of new methods to compute patient similarities able to fuse heterogeneous data sources with the available knowledge.

Materials and Methods

In this work, we developed a data integration approach based on matrix trifactorization to compute patient similarities by integrating several sources of data and knowledge. We assess the accuracy of the proposed method: (1) on several synthetic data sets which similarity structures are affected by increasing levels of noise and data sparsity, and (2) on a real data set coming from an acute myeloid leukemia (AML) study. The results obtained are finally compared with the ones of traditional similarity calculation methods.

Results

In the analysis of the synthetic data set, where the ground truth is known, we measured the capability of reconstructing the correct clusters, while in the AML study we evaluated the Kaplan-Meier curves obtained with the different clusters and measured their statistical difference by means of the log-rank test. In presence of noise and sparse data, our data integration method outperform other techniques, both in the synthetic and in the AML data.

Discussion

In case of multiple heterogeneous data sources, a matrix trifactorization technique can successfully fuse all the information in a joint model. We demonstrated how this approach can be efficiently applied to discover meaningful patient similarities and therefore may be considered a reliable data driven strategy for the definition of new research hypothesis for precision oncology.

Conclusion

The better performance of the proposed approach presents an advantage over previous methods to provide accurate patient similarities supporting precision medicine.

Development of Potent Inhibitors of the Mycobacterium tuberculosis Virulence Factor Zmp1 and Evaluation of Their Effect on Mycobacterial Survival inside Macrophages

The enzyme Zmp1 is a zinc-containing peptidase that plays a critical role in the pathogenicity of Mycobacterium tuberculosis. Herein we describe the identification of a small set of Zmp1 inhibitors based on a novel 8-hydroxyquinoline-2-hydroxamate scaffold. Among the synthesized compounds, N-(benzyloxy)-8-hydroxyquinoline-2-carboxamide (1 c) was found to be the most potent Zmp1 inhibitor known to date, and its binding mode was analyzed both by kinetics studies and molecular modeling, identifying critical interactions of 1 c with the zinc ion and residues in the active site. The effect of 1 c on intracellular Mycobacterium survival was assayed in J774 murine macrophages infected with M. tuberculosis H37Rv or M. bovis BCG and human monocyte-derived macrophages infected with M. tuberculosis H37Rv. Cytotoxicity and genotoxicity were also assessed. Overall, inhibitor 1 c displays interesting in vitro antitubercular properties worthy of further investigation.

Retention of Mitochondria in Mature Human Red Blood Cells as the Result of Autophagy Impairment in Rett Syndrome

Rett Syndrome (RTT), which affects approximately 1:10.000 live births, is a X-linked pervasive neuro-developmental disorder which is caused, in the vast majority of cases, by a sporadic mutation in the Methyl-CpG-binding protein-2 (MeCP2) gene. This is a transcriptional activator/repressor with presumed pleiotropic activities. The broad tissue expression of MeCP2 suggests that it may be involved in several metabolic pathways, but the molecular mechanisms which provoke the onset and progression of the syndrome are largely unknown. In this paper, we report that primary fibroblasts that have been isolated from RTT patients display a defective formation of autophagosomes under conditions of nutrient starvation and that the mature Red Blood Cells of some RTT patients retain mitochondria. Moreover, we provide evidence regarding the accumulation of the p62/SQSTM1 protein and ubiquitin-aggregated structures in the cerebellum of Mecp2 knockout mouse model (Mecp2^−/y) during transition from the non-symptomatic to the symptomatic stage of the disease. Hence, we propose that a defective autophagy could be involved in the RTT clinical phenotype, which introduces new molecular perspectives in the pathogenesis of the syndrome.

Multiple functions of insulin-degrading enzyme: a metabolic crosslight?

Insulin-degrading enzyme (IDE) is a ubiquitous zinc peptidase of the inverzincin family, which has been initially discovered as the enzyme responsible for insulin catabolism; therefore, its involvement in the onset of diabetes has been largely investigated. However, further studies on IDE unraveled its ability to degrade several other polypeptides, such as β-amyloid, amylin, and glucagon, envisaging the possible implication of IDE dys-regulation in the "aggregopathies" and, in particular, in neurodegenerative diseases. Over the last decade, a novel scenario on IDE biology has emerged, pointing out a multi-functional role of this enzyme in several basic cellular processes. In particular, latest advances indicate that IDE behaves as a heat shock protein and modulates the ubiquitin-proteasome system, suggesting a major implication in proteins turnover and cell homeostasis. In addition, recent observations have highlighted that the regulation of glucose metabolism by IDE is not merely based on its largely proposed role in the degradation of insulin in vivo. There is increasing evidence that improper IDE function, regulation, or trafficking might contribute to the etiology of metabolic diseases. In addition, the enzymatic activity of IDE is affected by metals levels, thus suggesting a role also in the metal homeostasis (metallostasis), which is thought to be tightly linked to the malfunction of the "quality control" machinery of the cell. Focusing on the physiological role of IDE, we will address a comprehensive vision of the very complex scenario in which IDE takes part, outlining its crucial role in interconnecting several relevant cellular processes.

Novel psychoactive substances in a psychiatric young adults sample: A multicenter, observational study

Introduction

Comorbidities between psychiatric diseases and consumption of traditional substances of abuse are common. Nevertheless, there is no data regarding the use of novel psychoactive substances (NPS) in the psychiatric population.

Objectives

The purpose of this multicentre survey is to investigate the consumption of a wide variety of psychoactive substances in a young psychiatric sample.

Methods

Between September 2013 and November 2015, a questionnaire has been administered, in ten Italian psychiatric care facilities, to a sample of 671 psychiatric patients (48.5% men; 51.5% women), aged between 18 and 26 years (mean age: 22.24).

Results

8.2% of the sample declared use of NPS at least once in a lifetime and 2.2% have assumed NPS in the last three months. The NPS more used were synthetic cannabinoids (4.5%), followed by methamphetamine (3.6%). The three psychiatric diagnosis with more frequent NPS consumption were bipolar disorder (23.1%), personality disorders (11.8%) and schizophrenia and related disorders (11.6%). Bipolar disorder was associated with NPS consumption (P < .001). Among the illicit drugs investigated, 31.4% of the sample was cannabis smoker and 10.7% cocaine user. Moreover, 70.6% of the sample declared alcohol use and 47.7% had binge drinking conducts. In univariate regression analysis, bipolar disorder was positive associated with binge drinking while obsessive compulsive disorder resulted negative associated.

Conclusions

The use of novel psychoactive substances in a young psychiatric population appears to be a frequent phenomenon, probably still underestimated. Bipolar disorder shows an association with NPS use. Therefore, careful and constant monitoring and accurate evaluations of possible clinical effects related to their use are necessary.

Disclosure of interest

The authors have not supplied their declaration of competing interest.